• Title/Summary/Keyword: Health Committee

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Conflict of Interest Groups on the Health Insurance Policy Deliberation Committee Affect the Medical Insurance Cost of Physical Therapy (건강보험정책심의위원회의 이익집단 간 대립이 물리치료 수가에 미치는 영향)

  • Kim, Yushin;Yoon, Bumchul
    • The Journal of Korean Physical Therapy
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    • v.25 no.2
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    • pp.43-48
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    • 2013
  • Purpose: The aim of this study was to demonstrate that non-participation of physical therapists on the political decision-making committee results in invasion of their interests. Methods: To demonstrate the effects, we analyzed the change of medical insurance score decided by the Health Insurance Policy Deliberation Committee between 2001 and 2012 years, focusing on medical examination as the interest of the participation group and physical therapy cost as interest of the non-participation group. Results: Total medical insurance cost increased by 23.72%, on average. Medical examination cost increased by 23.90% and 37.66% in medical examination for new and established patients, respectively. However, physical therapy cost was reduced by 5.01%. The medical examination cost for physical therapy without medical checkup increased by 2.62%. Conclusion: This study shows that the physical therapy cost, related on the interest of the non-participative group in the Health Insurance Policy Deliberation Committee, rather decreased while the total medical insurance cost increased.These findings demonstrate the invasion of the non-participative group on the Health Insurance Policy Deliberation Committee. Thus, aggressive participation in political decision-making committee is necessary in order to protect and increase rights and interests of Korean physical therapists.

A Study on a Direction of Improving the Health Insurance Appeal System in Korea (건강보험 권리구제제도의 개선 방향에 관한 연구)

  • Kim, Un-Mook
    • The Korean Society of Law and Medicine
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    • v.7 no.2
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    • pp.219-268
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    • 2006
  • In July 1989, Korea had achieved the national medical insurance system comprehensively covering the whole population since its inception of 12 years before, and subsequently the plural medical insurers had integrated to the unique health insurer system in July 2000. But there yet remain some problems to be improved under low contributions rates and poor benefit packages, especially the shortage of assuring beneficiaries' rights. The Health Insurance Appeal System is composed of a two-tiered system of committee. The Formal Objection Committees built in the National Health Insurance Corporation and in the Health Insurance Review Agency respectively examine the formal objections to the decisions of the Corporation, or the Review Agency. And the Dispute Mediation Committee built under the command of the Minister of Health and Welfare reviews the protests against the decisions on the formal objections by each Formal Objection Committee. To cope with the appellant in relation to the administration on the qualification of the insureds, contributions, and insurance benefits etc, is found to be unsatisfactory. There's the reason of poor function on right-relief caused by the loose composition of the Appeal Committee, the deficit of people's recognition and P.R., the lack of professional manpower and the Committee's independency, and time lag in making decisions and so on. Consequently the Appeal System should be improved to secure the rights-relief function, to empower the professionalism of the Appeal Committee, to strengthen P.R. for the beneficiaries, to build up the staff's proficiency through training, and to develop the quality of administrative services.

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A Descriptive Study of Occupational Health Services in Self-employed Enterprises (Nanoscale Enterprises), Shiraz, Iran

  • Jahangiri, Mehdi;Rostamabadi, Akbar;Yekzamani, Parvaneh;Abadi, Bahare Mahmood;Behbood, Fariborz;Ahmadi, Seyyedeh Fatemeh;Momeni, Zahra
    • Safety and Health at Work
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    • v.7 no.4
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    • pp.317-321
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    • 2016
  • Background: This study was conducted with aim of providing an overview of the current status of occupational health services and identifying the most common harmful agents at workplaces of Iranian self-employed enterprises (Nano-Scale Enterprises). Methods: A cross-sectional study was performed among a random sample including 1,758 employees engaging in self-employed enterprises with 5 and less employees. Results: Coverage of occupational health surveillance was very poor, annual health examinations were been conducted only for 64 (3.64%) of males and 31 (1.76%) of females, and occupational health trainings were not included of the services at all. Personal Protective Equipment were available in 462 (26.3%) of the enterprises. only in 0.4% of the enterprises working processes were been equipped by a local exhaust ventilation system. Difficult postures were the most common (81.5%) adverse working conditions. Conclusion: This study revealed a poor level of the implementation of occupational health services in Iranian self-employed enterprises. Based on the findings, providing basic training on the occupational health, more enforcing in conduction of health examinations and providing PPE, and taking appropriate strategies aimed at eliminating or minimizing work environment harmful agents are the major factor that should be considered to improve the level of occupational health services among the studied enterprises.

A Study on the Committees of University Hospitals in Seoul (병원의 위원회제도에 관한 연구 -서울시내 대학병원을 중심으로-)

  • Lee, Sun-Hee;Sohn, Myong-Sei;Lee, Kang-Young;Chae, Young-Moon;Choe, Heon
    • Health Policy and Management
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    • v.6 no.1
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    • pp.144-162
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    • 1996
  • This study was conducted to identify the problems related to operation of the committee system in university hospitals and to propose the direction for reforming it. Data were collected by surveying 138 working-level administration managers of committees from 12 university hospitals in Seoul in October, 1995. The results were as follows: 1. The purposes of the committee were to promote the reasonable dicision making in the hospitals, to satisfy the requirement of Hospital Accreditation Program and, to execute the administrational instructions in due order. The sort of job which was charged of chairmen and the majority of committee member was doctor. 2. The committees which were to be held the meeting frequently in a year were general management committees(8.25 times/year). But in case of operation rate, medical care-related committees showed the most frequent meeting(90.15%). Most of committees made the regulations and reported the results of their meeting to the CEO of their hospitals by written documents. 3. Most doctors thought the medical care-related committees useful. Medical technicians regarded education and research-related committees as useful, while administrators favored the general management committees. 4. The factors related to the perceived performance of the committee were the kind of job, the class of job and the kind of committee. Also, the perceived performance of the committee was positively related to the usefulness in efficient management of work, and negatively to uncertainties in responsibility and a nominal role of the committee. 5. Most of the respondnts thought that the concern of the top manager about the committee was the most important factor for the improvement of committee system at hospitals. They also regarded that formalization of the objectives and regulation rule and composition of committees with members which work in various fields as essential. Further studies on the organizational and operational cjharacteristics which include general hospitals in various areas are required.

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Access to Anti-smoking Information among School Children and its Potential Impact on Preventing Smoking Initiation: Results from the Global Youth Tobacco Use Survey (GYTS) 2014 in Viet Nam

  • Hoang, Van Minh;Kim, Bao Giang;Phan, Thi Hai;Trinh, Dinh Hoang;Doan, Thu Huyen;Luong, Ngoc Khue;Nguyen, Thuy Linh;Nguyen, Tuan Lam;Pham, Thi Quynh Nga
    • Asian Pacific Journal of Cancer Prevention
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    • v.17 no.sup1
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    • pp.31-36
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    • 2016
  • Scientific evidence on all aspects of smoking amongst youth is very important for designing appropriate interventions to reduce smoking among this vulnerable population. This paper describes current access to anti-smoking information among school children aged 13 to 15 years in Vietnam in 2014 and examines its potential impact on preventing smoking initiation. The data used in this paper were obtained from the 2014 Global Youth Tobacco Survey (GYTS) in Vietnam. Students were asked questions about their level of awareness of anti-smoking information from various sources in the past 30 days and about lessons in school regarding the dangers of tobacco use during the last 12 months. Those who have never smoked were asked "whether or not they thought about avoiding cigarettes because of health warnings on cigarette packages" and answers were analyzed in combination with data on access to anti-smoking information from other sources. The prevalence of exposure to antismoking campaigns was high among school children in Viet Nam: 55.3% of current smokers reported thoughts of smoking cessation because of health warnings on cigarette packages; 60.5% of never smokers avoided initiating smoking because of the same health warnings. The potential impact of graphic health warnings to prevent school-aged children from smoking initiation would be stronger if there was concurrent access to anti-smoking programs on the dangers of tobacco use in schools. However, school education for tobacco prevention and control has not been as strong as expected. A more comprehensive school curriculum on tobacco prevention and control is recommended to reinforce antismoking messages among school children.

Right-relief System of the Disputes to the Reviewing Medical Expenses in Health Insurance (건강보험 진료비 청구 및 심사지급에서의 권리분쟁과 구제)

  • Kim, Un-Mook
    • The Korean Society of Law and Medicine
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    • v.8 no.2
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    • pp.119-164
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    • 2007
  • Improving the formal objection system regarding reviewing medical expenses requires authority and confidence in the aspect of well-functioning the health insurance review and assessment system, legally and appropriately. The purposes of improvement of the formal objection system should aim for protecting the people's right of health. On handling the formal objections, the disputes of the rights should be settled economically and promptly by fairness, specialty, and objectivity in the health insurance review and assessment administration. Therefore, in order to promote the administrative specialty of health insurance, the formal objection committee needs to be organized independently and guaranteed expertly. Under the current formal objection system, however, the organization of committee lacks right-relief function, recognition and public relation as a health insurance appeal system, and related professional man powers. It is also analyzed that there are several controversial points, such as mass deliberation to the formal objection committee and its conference procedure. As a measure of improvement, it is analyzed that the committee needs to be organized independently with a proper number of professional man powers. The strict deliberation procedures and the prohibition of the decision-making by non-conference are also required to be empowered. The formal objection procedure provides the beneficiaries and the claims legitimately, so that it secures the legal relations on the health insurance system. Therefore, on the conference process of formal objection, the expert and guaranteed protection should be provided promptly, and its procedures to the appellants should also be assisted kindly.

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Problems and Solutions for Korean Medical Fee Contract System (건강보험 요양급여비용 계약의 문제점과 개선방안 연구)

  • Shin, Sung-Chul
    • Health Policy and Management
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    • v.19 no.1
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    • pp.1-30
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    • 2009
  • Korean medical fee contract system between the insurer and healthproviders was introduced in 2000. However, a continuous discord among contracting parties concerned and an irrational operation of an arbitration committee of Ministry for Health, Welfare and Family Affairs (MIHWAF) have made it difficult for them to reach to an agreement over last 8 years. The purpose of this study is to observe the current problems of contract system from the view of health insurance law and actual examples. Furthermore, I examined the of breakdown of negotiation by analyzing the eligibility of contracting parties, rationality of Resource Based Relative Value System (RBRVS) and contracting method and fairness of arbitration method in case of negotiation rupture. The results were as follows: First, since the introduction of medical fee contract system, there has been a problem in that both the president of National Health Insurance Corporation (NHIC) and health care provider association have not held strong negotiation power. Second, the frequent changes and notifications of Relative Value Units (RVUs) without any mutual consent between the insurer and provider association negatively have influenced the conversion factors and finally hindered the agreement of contract. Third, a current process that the conversion factors are mediated and determined at the arbitration committee of MIHWAF in the case of contract breakdown between contracting parties has some flaw in that the irrational composition of committee provoked the lack of fairness and objectivity of mediation. Fourth, we can not prospect a satisfactory outcome of arbitration committee because the mediation always has failed to proceed smoothly due to boycott of both committee members from insurer and providers over last 8 years. As a result, we have to make an every effort to resolve problems mentioned above and then dream of an advanced national health insurance system.

A Field Case Report on Oral Health Education Applying Intervention Activities in Some Areas of Hongcheon-gun (홍천군 일부 지역의 중재 활동을 적용한 구강보건교육 사례보고)

  • Min-A Kim
    • Journal of agricultural medicine and community health
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    • v.49 no.2
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    • pp.121-131
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    • 2024
  • Objective: This study is to design an intervention model for local residents to manage their oral health on their own. By establishing an autonomous participatory network without the intervention of external experts, it is possible to actively practice toothbrushing and use preventive services. Method: This is a case report study, and oral health education was conducted after interviews with 8 members of the Health Plus Village Committee in the N region of Hongcheon-gun and 156 residents of the senior center. Result: To foster oral health guardians in the community and to change behavior by actively sharing information and communicating with residents. It was confirmed that the Health Plus Village Committee was influential in spreading information, means, and interest about toothbrushing practices and preventive dental services to neighbors. Conclusion: In order to implement continuous resident-led oral health projects, resident-led village projects led by the Health Plus Village Committee should be activated through repeated empowerment education.